Bleeding In Space: How Do Women Astronauts Deal With Menstruation?

As menstruators, we all know the discomfort we face during the span of week-long bleeding. While some experience extreme pain in the abdomen that they aren't able to get out of bed, others face hormonal disbalance which leads to mood swings, depression and irritability. On the other hand, some feel okay and go about their day without any discomfort. So, every menstruator has a different experience of menstruation. What's common is the process of bleeding, hygiene and disposal. As terrestrial beings, this process is not unattainable. We have many resources to maintain hygiene during periods. But what about those who walk in the space? How is their menstrual cycle impacted by space factors? Is menstruation a hurdle between ambitious women and their dream to be in the space?

In 1963, Valentina Tereshkova, a Soviet cosmonaut, was the first woman to go to space. Since then, around 60 women have followed her footsteps. However, the issue of dealing with menstruation has always been a hurdle due to several factors. 

How menstruation was considered a barrier for women astronauts

When a woman went to space for the first time, no one knew what would be the consequences of menstruating in space. But later, it became a criteria to disqualify women. In 1964, the Women in Space Program said that onboarding “a temperamental psychophysiologic human” (women with hormonal changes) on a "complex machine" would not be a good idea. There were also concerns about “retrograde menstruation” due to microgravity impact. Retrograde Menstruation is a condition in which the blood flows backwards into the pelvic cavity rather than coming out of the body. 

People who were in support of women astronauts said that men are sent to space even though many things are unknown. Then why should this unknown impact on menstruation in space stop women? 

Rhea Seddon, one of the first six female astronauts at US National Aeronautics and Space Administration (NASA) said in an interview, as quoted by Firstpost, “We said, ‘How about we just consider it a non-problem until it becomes a problem? If anybody gets sick in space you can bring us home. Then we’ll deal with it as a problem, but let’s consider it a non-problem.’ "

First time when tampons were carried to space

NASA never thought of carrying tampons and sanitary napkins to space until 1983 when Sally Ride became the first American queer woman astronaut to go into space. Concerned about the load of things taken to the space, engineers asked Ride the number of tampons she would need. Ride had said, “I remember the engineers trying to decide how many tampons should fly on a one-week flight; they asked, ‘Is 100 the right number?’" Adding further, Ride quoted her reply, “No. That would not be the right number." 

But these stories belong to the time when there was no research on how the space environment affected women astronauts' periods.

Myths about menstruation in space busted

Now, research has proved that, unlike other body functions of a human in space, menstruation remains unimpacted. The blood flow is as same as any woman on the earth experiences.

Written by Virginia Wotring of the Center for Space Medicine at the Baylor College of Medicine and Varsha Jain, gynaecologist and researcher at Kings College London, the research "Medically induced amenorrhea in female astronauts" said that the previous concerns about the health of women astronauts bleeding in space and the possibility of blood clots have been proven wrong by the anecdotal experiences of the astronauts too. “No one has experienced anything,” wrote Wotring. 

The idea of retrograde menstruation has also been proved wrong by research and by the experience of women astronauts. The blood knows it has to come out and doesn't go back to the pelvic region due to microgravity. 

Varsha Jain wrote about the research in The Conversation and said, "When women first went into space, it wasn’t known what the effects would be." But, she added, even though the human body is heavily impacted by the space environment, women's menstruation doesn't change at all. She said, “It can happen normally in space, and if women choose to do that, they can."

This means that menstruation is certainly not affected nor does it affect a woman astronaut's health. So it cannot be considered as a barrier for women astronauts. In fact, women astronauts have the choice to either deal with menstruation in space or put a pause on it till the mission.

Challenges of menstruating in space

Talking about a few challenges that woman astronauts might face while menstruating in space, Jain mentioned in the article, "When making the decision a female astronaut may want to consider some of the challenges of getting periods in space. These tend to be related to the practicalities of hygiene – wash water is limited and changing sanitary products while floating in space would also be quite a task."

In addition to this, carrying and disposing of sanitary products will require the "cost of launching any extra payload into space." 

So, what is the option? 

How to pause menstruation throughout the space mission

If women do not want to deal with menstruation during their space journey, the best option is to take oral contraceptive pills which, as per the research, many women astronauts are opting for. The oestrogen-based contraceptive pill is used to pause ovulation. On earth, women take it for three weeks regularly to bleed in the fourth week. However, women astronauts can take this pill back to back to pause bleeding during their flight. Jain said that there are no harmful effects of this on a healthy and fit woman. 

In fact, studies show that it helps women astronauts. When human beings go into space, their bone density decreases as there is no load on it to strengthen it. "The lack of gravity means astronauts lose bone mineral density," Jain said. 

She further added, "And what we do know is that estrogen can help with density.” 

This means that the estrogen level in oral contraceptive pills can protect women from some of the bodily issues like loss of bone density while being in space. 

However, certain space journeys are as long as three years. Pausing menstruation for such a long period is viable? Around 1,100 pills will be required to pause periods for three or more years. 

But, Jain said that a number of different options are being explored. Until now, Jain said, "Long-acting reversible contraceptive (LARC) agents, implants that are typically put under the skin or within the uterus to slowly release menstruation-suppressing hormones, may be more convenient." 

Talking about the disposal and storage, she said, "[There is] no packaging to dispose of, and they dispel concerns regarding stability during storage.”

However, Jain mentioned that it is still not clear whether the implantation of LARC will be advantageous enough. It is not sure how it will fit in the specialised diving and spacewalk suits which are tugged close to skin. Moreover, LARC doesn't have estrogen which protects women's bone density. Therefore, more research needs to be conducted to know the viable options for women astronauts to deal with menstruation in space.